The cost of screening esophageal varices: traditional endoscopy versus computed tomography

Under current guidelines, patients diagnosed with cirrhosis are to undergo initial and continued screening endoscopy for esophageal varices throughout the course of disease. Recent literature suggests that computed tomography (CT) of the abdomen is adequately sensitive for detecting grade 3 varices, those in need of immediate intervention. This study presents a cost comparison of traditional endoscopy versus CT of the abdomen. Using TreeAge Pro software, a budget impact cost model was created for a hypothetical managed care organization covering 1 million lives over a 10-year period. Incidence figures for cirrhosis and the progression of esophageal varices were applied to the patient population. National Medicare reimbursement costs were used to compare screening with traditional endoscopy versus CT. Costs utilizing screening with combined endoscopy and CT were also examined. The results of comparing screening paradigms under a budget impact cost model results in an outcome measure termed "per-member, per-month" (PMPM) cost of implementing a new strategy. Computed tomography was the least expensive modality with an average 10-year cost per screened patient of $1097.30 and PMPM of $0.03. Endoscopy was the most expensive modality with an average 10-year cost per screened patient of $1464.89 and PMPM of $0.04. Computed tomography has been shown to be sensitive in detecting esophageal varices and now less costly to implement in screening. The cost of esophageal rupture in endoscopy and the less costly risk of contrast reaction as well as radiation exposure in CT of the abdomen should be considered when developing a screening paradigm.